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Which contraceptives are safe to use while breastfeeding?

There are many methods of contraception that are safe to use while breastfeeding – these include hormonal and non-hormonal methods. Contraception that contains the hormone progestogen has been shown to be safe and does not have any negative effect on breastfeeding or cause any harm to your baby.

Examples of contraceptives considered safe include the following:

Barrier methods – this includes the contraceptive diaphragm and cervical cap, which work by essentially blocking a woman’s egg from sperm (fertilisation). It’s best to check with your doctor about refitting the device since you might need a larger device after childbirth. This isn’t the most reliable method of contraception.

Condoms – these follow the same concept as the barrier methods – they work by ‘blocking’ the man’s sperm from reaching the woman’s egg. Remember that after childbirth, it’s quite natural for your vagina to be dryer than it had been before, so lubrication is recommended. It is important to know that this method has a much higher chance of pregnancy when compared to the hormonal methods.

Copper (intrauterine devices) IUDs – non-hormonal IUDs, like ParaGard, work by releasing copper into the womb. Copper affects mucus in the cervix, making it tough for sperm to fertilise an egg, and then for the egg to implant and survive. The IUD has also been shown to be safe and effective for roughly 10 years

Progestogen-only pill (the mini pill) – this has been proven effective for breastfeeding women when used every day. It might pass into the breast milk but doesn’t affect either the amount or the composition of your milk, and does not affect your baby, so is considered a safe option

Contraceptive implant– the contraceptive implant is a small plastic rod that is placed under your skin. It releases the hormone progestogen into the bloodstream to prevent pregnancy. Once inserted it is effective for 3 years

IUS (hormonal coil) – this is a small plastic device that is inserted into your womb. It releases the hormone progestogen into the womb to stop you from getting pregnant. It can be used for 3-5 years depending on the brand

Morning-after pill – this is an emergency contraceptive, which should only be used when necessary, rather than as a regular contraceptive (regardless of whether you’re breastfeeding or not). The most commonly used ones, like Levonelle or ellaOne, work by stopping or delaying the release of an egg (ovulation). If you use EllaOne you should not breastfeed for a week, however Levonelle is considered to be safe to use and you can continue breastfeeding

Which aren't safe during breastfeeding?

Go for 'oestrogen-free' options – if you’re breastfeeding, then you’re usually recommended to avoid any kind of contraceptive method which contains the hormone, oestrogen until at least 6 weeks after you have your baby. This is because oestrogen increases the risk of blood clots, which is also increased after childbirth, and while breastfeeding. After the first 6 weeks, even if you continue to breastfeed, these risks go down, so you could start taking one of these types of contraception after this time. There had been some suggestion that oestrogen could affect how well you produce breast milk, however the evidence is not clear and more recent studies suggest this is not the case. After 6 weeks you can start using combined contraception safely.

Examples of unsafe contraception include the following:

Combined oral contraceptive pill – this pill contains artificial versions of two hormones naturally made in your ovaries (oestrogen and progesterone). The hormones in the pill prevent the ovaries from releasing an egg each month (ovulation) so that a man’s sperm can’t reach it during sex and fertilisation can’t happen then.

Contraceptive patch – this is a small patch you stick to your body and that releases a dose of hormones (oestrogen and progesterone) every day through your skin into your bloodstream. It works in the same way as the combined pill since the hormones prevent ovulation.

Vaginal contraceptive ring – this is a soft, plastic ring that is fitted inside your vagina. Like the pill and patch, it works by releasing oestrogen and progesterone into the bloodstream so that ovulation doesn’t occur

Are natural contraceptives safer during breastfeeding?

Natural methods aren't necessarily 'safer' – there are many contraceptives that aren't considered 'natural' but can be safe during breastfeeding. Still there are quite a few 'natural' methods of contraceptives that you could consider if you don’t want to take any medication.

Lactational amenorrhoea method (LAM) – this might be one of the oldest forms of contraception and is when women use breastfeeding as their contraceptive method during the time they’re nursing. It works because breastfeeding affects your hormones, which can stop ovulation. It can be effective, but only under the right conditions, like when:

Your baby is younger than six months

You still haven’t had your periods

You’re only breastfeeding (without bottle or formula feeding) and do this regularly during the day (every four hours) and night (every six hours)

You don’t, or rarely, express milk (squeeze milk out of your breast for feeding later)

You don’t, or rarely, give your baby a pacifier

You can’t rely on LAM for birth control as your baby grows and you nurse less often, so you need to think about safe alternatives for contraception before you reach this point. Always talk to your physician if you’re unsure about what your next step should be.

Natural family planning – this can be a very effective natural method of contraception and involves monitoring the different aspects of your monthly period, like the length of your cycle, daily readings of your body temperature, changes in your cervical mucus. By tracking your cycle, you can calculate when you're most likely to be fertile (able to conceive), but you need to be careful since breastfeeding and/or recent childbirth may affect your signs of fertility. Some of the aspects to monitor are below:

Temperature – this is used because there’s usually a small rise in body temperature after ovulation. You’ll need to check your temperature every day with a specifically designed thermometer for this which is more accurate than a standard ear/forehead thermometer

Cervical mucus – throughout your cycle, there are changes in aspects of your cervical mucus (the amount and texture) and you can check for these to gauge when you’re least fertile and might be less likely to conceive

Rhythm method – you can track your menstrual history to predict when you’re most fertile and likely to conceive, so you can avoid having unprotected sex on those days. Some women might use this if they have religious reasons or a complex medical history, which may not allow them to use conventional contraceptive methods. There aren’t any direct risks associated with this method, but it’s considered one of the least effective types of contraception and its success rate is different between couples.

How soon after giving birth can you use contraception?

You can get pregnant as soon as three weeks after you give birth – this might surprise you but it's true; even if you're still breastfeeding and your periods haven't started again. This is because ovulation happens before your bleeding does.

Wait 6 weeks for combined hormonal contraception – if you are breastfeeding you’re recommended to wait at least 6 weeks after childbirth before using hormonal birth control that contains both oestrogen and progestin (e.g. the pill, the vaginal ring, the patch). It’s important you’re careful about this, since using them too soon after childbirth could put you at a high risk of dangerous blood clots. Talk to your doctor before making any decisions, as in some cases you might need to wait for longer or consider a different type of contraception altogether e.g. if you have other risk factors for blood clots, like a history of clots, being overweight or a smoker. If you are not breastfeeding then combined contraception can be started three weeks after childbirth, as long as you do not have any other risk factors.

Many other contraceptives can be started sooner – the other types of contraception, including the mini-pill, the implant and barrier methods can be started at any time after childbirth. The copper coil (IUD) or hormonal coil (IUS) can sometimes be fitted immediately after childbirth or in the first 48 hours, otherwise you need to wait until 4 weeks after childbirth to use these.

A doctor can check the right contraception for you – if you are prescribed any other medications after pregnancy, including antidepressant medications of postpartum depression, you should make sure that you let your doctor know that you are taking these when you discuss your contraception options as this might affect what type of contraception would be safest and most suitable for you.

Is bottle feeding a better option if you want contraception?

There are many safe contraceptive options during breastfeeding so bottle-feeding is not necessary unless it's the right choice for you.

Bottle feeding can affect how quickly you start to ovulate – if you’re breastfeeding your baby (without bottle feeding), your monthly cycle could shift and become later. On the other hand, if you’re formula-feeding exclusively (no breastfeeding at all and no pumping) your ovulation and menstruation will return much more rapidly and can even restart as early as the very next month after childbirth. After 6 weeks, there are no restrictions on the type of contraception that you are using if you are breastfeeding. However if you wanted to start a combined contraception before 6 weeks then you would not be able to do so while breastfeeding.

Breast milk is recommended – breast milk is designed for your baby, so it is recommended for roughly the first six months. It can offer a lot of benefits if you breastfeed:

Health benefits – certain studies suggest that moms who breastfeed are less likely to develop breast cancer, ovarian cancer, and osteoporosis. Nursing mothers are also less likely to deal with postpartum depression or Type 2 diabetes.

Bonding – breastfeeding can build a strong emotional bond between you and your baby

Expenses – it is cheaper than formula feed (however, this might depend on your diet during breastfeeding too)

Bottle-feeding does have some advantages – formula feeding is considered a less natural method of feeding since it involves mixing a nutrient-rich formula to feed your baby. It doesn’t make use of your breast milk at all, which means that you can use any contraceptive method. This type can offer some other benefits:

More contraceptive choice – you don't have to avoid oestrogen-containing contraceptives, like when you breastfeed

Precision – you can be precise, since you measure exactly how much you are feeding your baby. This can also be helpful if you want to plan/understand how much to feed your baby later too.

Responsibility sharing – whether you’re formula or bottle feeding, the method can be great in making sure the work of feeding is shared between a couple or family members. This can be a great relief for the mother and may allow her some rest, since feeding is generally every few hours.

Flexible diet – if you’re formula feeding, the mother has the freedom to eat and drink things like caffeine, alcohol and take in more calories if she likes, since she doesn’t have to worry about meeting the needs of her baby

Less frequent feeding – formula-fed babies will generally eat less often than breast-fed babies, because baby formulas take longer to digest than mother's milk

There are a lot of benefits and disadvantages of each type of feeding but, ultimately, the decision is your own. You should talk to your physician if you want some advice, and you should consider the risks and benefits of each method to both you and the infant and how these play into your choice of contraception. It’s a balancing act; you need to ask yourself what the most important things are and whether these are achievable simultaneously.